Staging of primary cervical cancers: the role of nuclear medicine

Whole-body 18FDG PET plus pelvic MRI in the pre-treatment assessment of cervical cancers: an alternative to the FIGO clinical staging

“…In the M staging of cervical cancers, growing evidence indicates the usefulness of 18 FDG PET for more appropriate treatment planning. In agreement with some authors, we advocate the introduction of metabolic imaging in the initial work-up of women presenting with cervical cancers [13,14,21,32]. So far, more data need to be gleaned in order to refine the correct place of 18 FDG PET on a stage-by-stage basis.…”

“…In the assessment of primary cervical cancers, the value of MRI is well documented [4,5,16,17]. More recently, increasing amounts of data also have shown that 18 FDG PET may detect an intense metabolic signal at the level of the primary site with a high sensitivity (81-100%) [10,11,12,13,14,18,19,20]. When the performances of both imaging modalities were compared in a prospective series including 22 patients with histologically proven cervical cancers, a similar sensitivity of 91% was found.…”

“…In this particular clinical context, 18 FDG PET may be the best alternative for highly sensitive whole-body imaging, which allows the localisation of metastases at each level of the natural history of nodal spreading. Indeed, many clinical reports have shown the added value of metabolic imaging for detecting lymph node metastases at the pelvic and extra-pelvic levels [10,14,18,19,20,21]. Quiet frequently, 18 FDG PET alone was able to detect nodal involvement missed by the CT and/or MRI [18,19,20,21,31].…”

“…Although lung, liver and bone metastases are the most frequent sites of secondary localisations arising from cervical cancers, results from large surgical series and autopsy studies showed that a large spectrum of organs may be affected with a variable frequency [35]. Also, 18 FDG PET appears particularly appropriate for the detection of distant tumour sites through the entire body [13,14,32,36]. Interestingly, cervical cancers exhibit high rates of GLUT-1 (type-1 glucose transporter) and glycolytic enzymes (type-2 hexokinase, phosphofructokinase and pyruvate kinase), which makes the imaging by means of the glucose analogue theoretically and practically valid for such gynaecological malignancies [37,38,39,40,41].…”

“…In recent years, many reports demonstrated the clinical usefulness provided by whole-body 18 F-fluorodeoxyglucose positron emission tomography (wb- 18 FDG PET) as well as by pelvic magnetic resonance imaging (pMRI), respectively, in the initial assessment of uterine cancers [4,5,10,11,12,13,14]. The purpose of this paper was to assess the appropriateness of wb 18 FDG PET plus pMRI in the pre-treatment staging of primary cervical cancers on the basis of the TNM classification.…”